血浆NGAL和BNP水平对急性肾功能损害患者肾功能恢复的预测作用研究

Prediction of Plasma NGAL and BNP Levels on Renal Function Recovery in Patients with Acute Kidney Injury

目的探讨血浆NGAL和BNP水平对急性肾功能损害患者肾功能恢复的预测作用。方法选取2017年1月~2020年12月在我院就诊的急性肾功能损伤患者共130例。根据AKI是否恢复,将患者分为AKI恢复组和AKI未恢复组,其中AKI恢复组84例,AKI未恢复组46例。比较两组患者的临床资料、血浆NGAL、BNP水平等;并运用ROC曲线分析血浆NGAL和BNP水平对AKI患者肾功能恢复的预测作用。结果AKI恢复组APACHEⅡ评分和SOFA评分均显著小于AKI未恢复组(P<0.05),两组患者AKI发病前血清Cr基线水平无明显差异(P>0.05)。诊断AKI时,AKI恢复组患者的血Cr、NGAL和BNP水平都显著低于AKI未恢复组(P<0.05)。AKI恢复组患者住院死亡率和28天内死亡率均显著低于AKI未恢复组(P<0.05),AKI恢复组患者平均住院天数为18.48±4.22天,显著短于AKI未恢复组21.04±6.41天(P<0.05)。NGAL对AKI恢复的预测AUC为0.684,敏感性为92.48%,特异性为41.09%;BNP预测AKI功能恢复的AUC为0.784,敏感性为84.23%,特异性为64.21%。NGAL和BNP联合预测AKI患者肾功能是否恢复的AUC为0.803,敏感性为93.84%,特异性为59.06%。结论NGAL、BNP及两者联合均对AKI患者肾功能恢复情况具有一定的预测作用;NGAL联合BNP对预测AKI肾功能恢复具有更好的敏感性。

Objective To study the predictive value of plasma neutrophil gelatinase-associated lipocalin(NGAL)and B-type Natriuretic peptide(BNP)levels on renal function recovery in patients with acute kidney injury(AKI).Methods A total of 130 AKI patients admitted to our hospital between January 2017 and December 2020 were selected.Based on whether AKI recovery or not,patients were divided into two groups:the AKI recovery group(84 cases)and the AKI non-recovery group(46 cases).Clinical data,plasma NGAL and BNP levels were compared between two groups.The predictive value of plasma NGAL and BNP levels on renal function recovery was analyzed by ROC curve.Results The APACHEⅡscore and SOFA score in AKI recovery group were significantly lower than those in non-recovery group(P<0.05),and there was no significant difference in the baseline serum Cr levels with AKI onset time between two groups(P>0.05).At time of AKI diagnosis,the serum levels of Cr,NGAL and BNP in AKI recovery group were significantly lower than those in non-recovery group(P<0.05).The in-hospital mortality and 28-day mortality of patients in AKI recovery group were significantly lower than those in non-recovery group(P<0.05).The average length of stay(ALOS)in AKI recovery group was 18.48±4.22 days,which was significantly shorter than that in non-recovery group(21.04±6.41 days,P<0.05).The AUC of NGAL for AKI recovery was 0.684 with a sensitivity of 92.48%and a specificity of 41.09%.The AUC,sensitivity and specificity of BNP for predicting AKI function recovery was 0.784,84.23%and 64.21%respectively.The AUC of NGAL in combination with BNP to predict the recovery of renal function in AKI patients was 0.803,with a sensitivity of 93.84%and a specificity of 59.06%.Conclusion NGAL,BNP alone and their combination have a certain predictive value on renal function recovery in AKI patients.NGAL combined with BNP has a better sensitivity to predict renal function recovery in AKI.